Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria are geared towards younger adults and may not appropriately screen and diagnose older adults. Social and occupational impairments due to alcohol use may go unnoticed or unreported for older adults who are retired, live alone, or are socially isolated 4•. However, many older adults continue with problematic drinking at the same level as they have for years and may have problematic use without efforts to cut back and at lower levels of use compared to younger adults 6. Additionally, AUD in older adults can mimic other diagnoses which are common in later life, such as cognitive impairment or depression. Ageist beliefs among patients, family members and providers pose additional barriers to diagnosis and treatment.

A 2017 study involving older adult men found that they will pee more when drinking stronger alcoholic drinks, such as spirits, compared with nonalcoholic drinks. So, for an older adult already experiencing dehydration symptoms, consuming alcohol may make the symptoms worse. Long-term alcohol problems can affect the body’s ability to absorb nutrients, and put the person at increased risk of certain brain conditions, including alcohol-related dementia, pseudo-Parkinsonism (trembling, etc.) and peripheral neuropathy (tingling or numbness in the hands and feet). Alcohol abuse in older people has become more common in the past few decades. Depressive symptoms like insomnia, mood swings, and anxiety can mimic those of alcoholism.

How Are Substance Use Disorders Diagnosed?

For patients seeking an alternative to AA, Self-Management and Recovery Training (SMART) differs from AA in that it is run by trained volunteers and is based on principles of cognitive behavioral therapy (CBT) and motivational interviewing (MI). Some of the CBT and MI skills include building and keeping up motivation, coping with urges, managing thoughts, feelings, and behaviors, and living a balanced life 14•. During the COVID-19 pandemic, mutual-help groups are more likely to be occurring through “virtual” platforms such as video or telephone which can be an advantage for patients needing to physically distance or if transportation is a barrier.

Older adults are not a homogenous group, however, and their presentations may vary based on medical comorbidities, lifestyle factors, and duration and severity of substance use. Additionally, they may have a range of opinions and attitudes towards substance use; thus, an age and culturally sensitive and individualized approach can improve treatment outcomes 3. Some adults over 65 years of age may have better physical health status than their similarly aged peers. On the other hand, chronic alcohol use contributes to increased morbidity, exacerbation of existing health conditions, and neurotoxic and neuropathological changes 5. Despite this growing problem, AUD in later life is often underdiagnosed, underreported, or overlooked, and consequently is often not managed 4•.

AUDIT and AUDIT-C

• If people who are alcohol dependent suddenly stop drinking, they may experience withdrawal.
• Mutual-help programs can include more structured programs such as Alcoholics Anonymous (AA) which help connect patients to a network of peers to whom they can relate 14•.
• The U.S. Preventive Services Task Force (USPSTF) recommends screening older adults for alcohol misuse and brief counseling for those who misuse alcohol 15.
• A 2017 study involving older adult men found that they will pee more when drinking stronger alcoholic drinks, such as spirits, compared with nonalcoholic drinks.
• Over time, even if there are no changes to the amount of alcohol you or they drink, the body will begin to process it differently.

The MAST is highly sensitive and specific and generally has strong psychometric properties.102 It is also administered in a short form, the SMAST-G, which has 10 questions, with 2 positive responses indicating a problem with alcohol. Because of the diagnostic challenges outlined earlier, the MAST-G focuses more on potential stressors and behaviors relevant to alcohol use in late life, as opposed to questions toward family, vocational, and legal consequences of use. This tool has many of the advantages older adults alcohol abuse info of the CAGE, such as ease of administration and low cost. Although useful as an indicator of lifetime problem use, it lacks information about frequency, quantity, and current problems important for intervention.

• Although useful as an indicator of lifetime problem use, it lacks information about frequency, quantity, and current problems important for intervention.
• Depending on the patient’s needs and treatment goals, treatment may be able to be provided in a primary care or general mental health setting; alternately, referral to specialty treatment may be indicated.
• A complete substance use assessment includes full mental health, medical, family, vocational, social, sexual, financial, legal, substance use, and SUD treatment histories.
• As an older adult, you may or may not notice some changes in the way alcohol makes you feel, and you may face some unique challenges when it comes to managing health conditions or medications.

Naltrexone is the most well-studied medication used for SUD treatment among older adults,112 and it has demonstrated some effectiveness with this population. Naltrexone is an opioid receptor antagonist thought to reduce craving and the pleasurable or stimulating effects of alcohol by blocking alcohol-induced dopamine release in the brain.123 It can be taken daily or as needed, although only daily treatment of naltrexone has been tested with older adults. The standard dose of naltrexone is 50 mg, but some studies have investigated its effects at larger doses (eg, 100 mg).

Alcohol Can Negatively Affect Cognitive and Mental Health

Once the patient has completed any necessary steps for medical stabilization including outpatient or inpatient detoxification and has been able to consistently abstain from alcohol use, they may need ongoing assistance with recovery management support. Patients that are more likely to need ongoing recovery support may include patients with co-occurring medical conditions or psychiatric disorders and individuals with limited social support 36. The Michigan Alcohol Screening Test-Geriatric Version (MAST-G)101 is an instrument designed to identify drinking problems and was developed specifically for the elderly by modifying the Michigan Alcohol Screening Test. This screening tool contains 24 questions with yes/no responses; 5 or more positive responses indicate problematic use.

Worsening health conditions

Alcohol misuse and alcohol-related harms are also increasing among this population, and at a faster rate for women than men. Alcohol misuse refers to drinking in a manner, situation, amount, or frequency that could cause harm to the person who drinks or to those around them. Alcohol misuse includes binge drinking and heavy alcohol use as well as consumption at lower levels for some individuals. Although some older adults may have enjoyed a certain amount of alcohol on a regular basis for years without any apparent problems, they might notice that they now feel the effects of alcohol are more pronounced and come on more quickly. As people age, changes in their bodies, as well as in their physical and mental health, may cause alcohol to affect them differently than when they were younger and put them at greater risk for negative consequences. Understanding how alcohol affects the health of older adults can help them and their health care providers make informed decisions about their health and well-being.

Alcohol & Substance Abuse

Many older adults experience issues with balance due to physical changes such as a loss of muscle mass and diminished range of motion. Adding the heightened effects of alcohol to this equation can increase the fall risk that some older adults face. Drinking alcohol poses various health and safety risks for older adults, such as exacerbating balance problems and increasing fall risk. The Dietary Guidelines of America do not recommend drinking alcohol if you haven’t already started, but if you do, it’s important that you drink moderately. Reaction times, balance, and coordination can naturally become more challenging for older adults, and as drinking alcohol also affects these functions, it can increase the risk of falls, vehicle collisions, and other accidents.

If you answered yes to one or more of these questions, talk to your doctor or an addiction professional to help you decide whether you might benefit from treatment or other support. If you do decide to drink, professionals recommend that people over 65 shouldn’t take more than one standard drink each day and no more than 7 each week. Of course, this amount may vary depending on your own health and body type. Not only will alcohol make conditions like hypertension and diabetes worse, but it also mixes poorly with the medications typically used to treat those conditions. Reduced coordination, balance difficulties, and cognitive impairment have different implications for older adults than they might for younger adults. Alcohol slows reaction time and reduces coordination, exposing older adults to a range of other potential accidents, including automobile accidents.

There is no completely “safe” level of alcohol consumption, especially as you age. Older people who get professional help for their drinking problems are often able to cut down or quit drinking, and stick to these changes, even more successfully than younger adults. Even if you have tried treatments or other supports before, it is always worth trying again. While the easiest way to avoid problems with alcohol is to not drink at all, many people enjoy alcohol and choose to continue drinking as they get older. If you drink, the following guidelines can be used to help keep your drinking at a level that is considered low risk. In recent years, scientists have been investigating how alcohol consumption affects aging.

As a result, older adults could develop alcohol-related problems at lower drinking amounts than younger people. As the baby boomer generation moves into retirement age, it is expected that by the year 2034, older adults (ages 65 and up) will outnumber children in the United States for the first time in history. As the population ages, demand for healthcare will increase, and rising rates of alcohol use in older adults may create additional challenges to an already burdened healthcare system. A 2022 study also looked at the genetic effects of drinking — specifically telomere length — and found that consuming alcohol accelerates aging by damaging DNA. Excessive consumption can lead to dependence, and the higher blood alcohol concentrations that people may experience in older age can accelerate the rate of dependence.

Family members may believe that SUDs in late life do not exist or do not need treatment, and consequently overlook substance use among older adults. Finally, healthcare providers may refrain from asking about substance use due to fear of offending older adults or may focus more on their reports of physical complaints 7. Alcohol affects older adults differently than younger adults due to age-related physical changes including decreased lean body mass and total body water, decreased liver metabolism, and increased blood-brain barrier permeability and neuronal sensitivity to alcohol 1. Consequently, older adults have higher blood alcohol concentrations and increased impairment compared to younger adults with equal levels of consumption. Older adults are more likely to be taking multiple medications which increases their risk for drug-drug interaction and falls.

Follow NCOA on Social Media:

Two additional medications with off label use for alcohol use disorder are gabapentin and topiramate 37. None of these medications are specifically contraindicated for use in older adults, but caution should be exercised when using these pharmacologic agents in this population (Table 2). Problem substance use is characterized by those individuals who are already experiencing problems in the aforementioned areas as a result of their use. Identification of problem use among older adults does not depend on the quantity and frequency of use but on the context in which substances are used. For example, older adults may experience extreme problems with alcohol even when ingesting it at minimal levels because of medical conditions, such as gout or pancreatitis.

The Alcohol Use Disorders Identification Test

If you or an older adult you care about is struggling, dial or text 988 now to speak with a Lifeline counselor. Having a couple of drinks with friends or to unwind at the end of the day is a standard practice among many adults. Dehydrogenase, an enzyme that breaks down alcohol, becomes less active with age. This can be dangerous for people who already have slower reaction times and poor balance without alcohol.